title: Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study.
abstract: OBJECTIVE
  Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants.
  
  
  METHODS
  All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf® administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf®administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assessment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) ≥ grade III).
  
  
  RESULTS
  Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage >3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH ≥ grade III when compared to the LS treatment group.
  
  
  CONCLUSIONS
  ES treatment decreases IVH (≥ grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.
authors.affiliation: Zekai Tahir Burak Maternity and Teaching Hospital, Neonatal Intensive Care Unit , Ankara , Turkey .
authors.forename: Uğur
authors.initials: U
authors.lastname: Dilmen
authors.forename: Ramazan
authors.initials: R
authors.lastname: Özdemir
authors.forename: Hatice
authors.initials: H
authors.lastname: Tatar Aksoy
authors.forename: Nurdan
authors.initials: N
authors.lastname: Uras
authors.forename: Nihal
authors.initials: N
authors.lastname: Demirel
authors.forename: Ercan
authors.initials: E
authors.lastname: Kırimi
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Erdeve
authors.forename: Esra
authors.initials: E
authors.lastname: Özer
authors.forename: Ahmet Yağmur
authors.initials: AY
authors.lastname: Baş
authors.forename: Tuğba
authors.initials: T
authors.lastname: Gürsoy
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Zenciroğlu
authors.forename: Fahri
authors.initials: F
authors.lastname: Ovalı
authors.forename: Ş Suna
authors.initials: ŞS
authors.lastname: Oğuz
mesh_terms: D001688:Biological Products / Q000008:administration & dosage* / Q000627:therapeutic use; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D020300:Intracranial Hemorrhages / Q000517:prevention & control; D008297:Male; D010743:Phospholipids / Q000008:administration & dosage* / Q000627:therapeutic use; D011030:Pneumothorax / Q000517:prevention & control; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use; D012121:Respiration, Artificial; D012178:Retinopathy of Prematurity / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa